El-Sayed Essam—a physiotherapist from Egypt—published a randomised trial in the Journal of Physiotherapy that estimated the effects of trunk stabilising exercises during the postoperative period.

How common is sternal instability after cardiac surgery? 

According to the literature in this area, there may be complications in healing after median sternotomy, including instability in the sternum, non-union and an infected wound. 

Such major problems are rare, ranging from 0.3 per cent to five per cent, but can be destructive.

Does ongoing sternal instability just cause discomfort and the sensation of movement (which must be disconcerting) or are there other problems associated with delayed sternal healing?

After cardiac surgery through median sternotomy, the patients had sternal instability that caused pain as well as discomfort and the sensation of the movement of a divided sternum, leading to reduced quality of life for those patients.

What sort of participants were in the trial?

The participants were women who underwent heart valve surgery through a longitudinal median sternotomy.

What interventions did they receive?

They received trunk stabilising exercises, a routine cardiac rehabilitation program and sternal precautions.

What were the results of the trial?

There was a significant difference in sternal stability improvement between groups in the trial, with much greater improvement seen in the intervention group (who received trunk stabilising exercises).

Where should research in this area move to next?

Further studies are recommended, incorporating other treatment strategies for sternal instability after median sternotomy.

>>El-Sayed Essam El-Sayed Felaya PhD is a lecturer in the Department of Physical Therapy for Internal Medicine, Faculty of Physical Therapy, Cairo University and Assistant Professor at the School of Physiotherapy, University of Hertfordshire, hosted by Global Academic Foundation, Egypt, with a speciality in physical therapy for cardiac and cardiothoracic surgery.